Case study 3: East Dorset
Interview with Steve Duckett, Head of Public Health Services, East Dorset District Council.
Head of Public Health Services, Steve Duckett of East Dorset Council has led the development of a health improvement statement for the council. He first became involved when he was asked by the Dorset Primary Care Trust (PCT) to contribute to training a public health trainee. This he believes was the first step in getting members educated about the health role of local government.
National Service Frameworks
The Department of Health's (DH's) National Service Frameworks (NSFs) are a series of documents setting the NHS standards for different user groups and conditions. These include mental health, older people and diabetes.
In developing the health improvement statement for Dorset Council, Duckett has analysed each one of the NSFs. He has been looking at the potential contribution of local government - including Regulatory services - to the standards. This has already led to developments in the work programmes of several of the Regulatory services.
Health and safety inspectors have been trained in smoking cessation techniques. The aim is to make interventions on smoking when they carry out their normal inspections. And there are also plans to use the regular meetings that the Licensing team has with licensees to talk about alcohol harm and how it can be reduced. Due to its entrepreneurial spirit and its willingness to ‘use the teachable moment', as Duckett phrases it, the district council has just been commissioned by the PCT to run its Healthy Options Awards.
The work is carried out with the county council Trading Standards team across the county. Through using the NSFs to look at local government's role, Duckett believes he has been able to draw in the NHS locally to the council's work. In turn this has also helped NHS partners to understand the local authority contribution to health.
Health and wellbeing board of the LSP
Another useful vehicle for strategic joint thinking has been the Health and Wellbeing Partnership Board of the local strategic partnership (LSP), of which Duckett is the Vice-chair. He considers this to be a good use of his time, not least because his opposite number from the county council's Trading Standards service is a member. But he also sees it as an opportunity to develop elected members' understanding of the links between Regulatory services and health. He says:
“We're very much at an early stage with members. This work is taking us and them slightly out of our comfort zone and into that uncomfortable area where transformational change takes place. We have to remember that it takes a certain courage and far-sightedness for members to put resources into improving their population's health, because they may not see the outcomes during their own term of office.”
Other regulatory services staff now contribute regularly to partnership activities, including attending Health and Wellbeing Partnership Board meetings when appropriate.
“We come to the table for the items where we believe we can have an impact - I consider this to be an important, strategic use of Regulatory services' time.”
He believes that reconnecting these services with explicit health improvement goals is not a question of creating new structures but of re-drawing and redefining previous links.
Education and training for health improvement
In the last few years, Duckett has noticed a different approach among the young people who have just completed their training in Regulatory services.
“There is a much more holistic approach. They are moving away from the narrow understanding of regulation that has developed, no longer seeing it as a form of policing, but as an opportunity to improve services. This means that they are more willing to try out new ways of working.”
An important example of a new willingness to recognise each other's contribution to health is the fact that the NHS in Dorset has paid for, and the local authority has agreed to release, five of its staff to attend a training programme on leadership for health and wellbeing. These include two environmental health officers, one trading standards officer, a member of staff from Children's services and an officer from the county's fire and rescue service, as well as a public health consultant.
“Joint training is incredibly important. It exposes people in both directions to each other's work. It gives them time out to think and question their own assumptions.”
Social model of population health
Duckett has been an advocate of a social model of population health for many years, in contrast to the medical model which he believes has prevailed in the past. He says:
“I've found a sympathetic ear among public health professional colleagues. For the first time in my life I'm beginning to see some tangible outcomes, recognising the health impact of local government, such as the NHS funding our staff to attend health-related training.”
An aspect of medical colleagues' training that Duckett thinks it is important to learn from is their insistence on an evidence base for their interventions.
“I've learned that public health never does anything without evidence. In contrast, when you look at some environmental health interventions, you have to question where the evidence is for their effectiveness. This is definitely something we can learn from them.”
He mentions research which correlates the hazard rating system for housing repairs with the number of hospital bed days taken up by older people in an area. He says:
“This is the sort of research that can help to show the value of investing in population health interventions and can also show us what the most effective interventions will be.”
He also sees as a hopeful sign the fact that the South West Regulators Forum, which he chairs, has begun to discuss the health role of local authority regulatory services and research of the kind referred to above.
The next step for East Dorset District Council will be to develop an action plan to accompany its health improvement statement. In a mark of the increasing recognition of each other's contribution to health improvement and reducing health inequalities, the PCT has agreed to put funding towards developing this action plan. The aim is to relate this, not only to the district council, but also to the other district councils in the area and the county council, with the eventual objective of having a health strategy for the whole of Dorset.
4 December 2009